Question 1 (1 point)

What is the purpose of managed care?

Question 1 options:

A)	to reduce the costs of healthcare services
B)	to improve the quality of care for patients
C)	to leverage negotiations with state and federal agencies
D)	A and B only
E)	all of the above

Question 2 (1 point)

Which of the following is an example of fraud?

Question 2 options:

A)	perform a battery of diagnostic tests when only a few tests are required for services
B)	Submit bills to Medicare and not to third party payers (ex: claims for injury from an automobile accident, in a store, or at the workplace)
C)	alter fees on a claim form to obtain higher payment
D)	fail to make required refunds when services are not necessary

Question 3 (1 point)

Which type of healthcare insurance policy provides benefits to a resident requiring nursing home care and services?

Question 3 options:

A)	long term care or extended care insurance
B)	accidental death and dismemberment insurance
C)	disability income protection insurance
D)	major medical
E)	Medigap

Question 4 (1 point)

Which discounted fee-for-service healthcare payment method does Medicare use to reimburse physicians?

Question 4 options:

A)	ACO
B)	UCR
C)	CPR
D)	RBRVS

Question 5 (1 point)

Which type of healthcare insurance policy provides benefits to pay for Medicare deductible and coinsurance?

Question 5 options:

A)	accidental death and dismemberment
B)	comprehensive
C)	Medigap
D)	disability income protection
E)	major medical

Question 6 (1 point)

Which piece of legislation penalizes federal contractors who knowingly file false or fraudulent claims in order to defraud the US government?

Question 6 options:

A)	social security act
B)	Medicare modernization act
C)	false claims act
D)	affordable care act

Question 7 (1 point)

In the healthcare industry, what is the term for the written report insurers use to notify insured about the extent of payments made on a claim?

Question 7 options:

A)	certificate of insurance
B)	coordination of benefits
C)	explanation of benefits
D)	summary of benefits and coverage

Question 8 (1 point)

Denial rate is a:

Question 8 options:

A)	measure of the effectiveness of coding management
B)	measure that assesses the ability to comply with billing edits
C)	measure of the health of the claims generation process
D)	measure of how well a facility or practice complies with billing rules and regulations for all payers

Question 9 (1 point)

All of the following are goals of a denials management team EXCEPT:

Question 9 options:

A)	reducing the number of denials
B)	identifying documentation deficiencies
C)	identifying the source of denials
D)	developing physician and staff knowledge of documentation regulations

Question 10 (1 point)

What is the term for an MCO that serves Medicare beneficiaries?

Question 10 options:

A)	Medicare Advantage
B)	Social Foundation
C)	Part A
D)	Exclusive Provider Organization